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<br />A. llU'j'ICE: Oli' DIl1HlIJ RIilB'J'HIC'j'IONS
<br />'I'll}! \llldel:sluueu lllluel;attlllda that Lids pi::nlllL 1i1~~' Ill;; :;ql!:le;JI. to "deed l:esl:l:11J1:IDlIS" \'Ildull
<br />IiICl)l j)f:l IIlOl:e rei:ll:LJcI:Ive I;han CIty reglll"l;loiJS. I'h", undtH::llynE:ld aSS\lllles J.:esponsl.bl1.11:\' fDr
<br />uDmpllalllle I/Jth any tli1pllcaLle deed l:ef.ltdc1d,l,I=.
<br />B. IINLICfilNBIlJU CON'I'HA(J'I'OHS }HIIJ COll'l'Hl\C'I'OR RmS?UHSJBII,I'l'TH:~
<br />1 t the (Jlme 1: Ila s hi I:ed a UOII t 1:01 llt () r () 1: COli t 1:<1 IT,:c 1.:1 t () ll11d,~ r t a I; Cl \'In r II, l.hey llli:l y be l'iI"jll:I red
<br />'/Iu be J.1otlllsed.\.1I iHJOordanoe viJ,t:ll atal.e and 11)Ci~L reglt1al.lollS. It the uOlIl:l:i:luLpl: .16 !lOl.
<br />Ullellsed as tecptl led by ] aw, both l:llb O\'/ller alld :::ulll:C1:tuLor Hlay be ClIl:..d for. a lid tldeHhHllIor
<br />,liD} atillll linder' stat:e 1 a\!. 1 f the OHIH:lr or .1.1I1;t.dded uOlJel:aut:Ol.' are \l\lccuLa.lll lilS I',D Hllal'
<br />ItuellaJIHj relJ\Lirelilellts lIIay apply fot' tile lntendt:d IHnll.. elley are advJf.li;d to f.l(lllLiHl1: t:lle
<br />1:ILy of l?,epllvdd Ll /;j auJldlug Dcpfu,::tlllenL, fJ1.3-c11JIl'6611,
<br />li'IHLllerlllDU::, It the Ollller has Id.J:ed a oOlllraol:()J; or uonl:raolors, he l./;l advlsed 1:0 hav= the
<br />Clmlt!;'ClCJtO.l: (El) aJgll port.ionEl of the "Contraotor lJect:iollSTI of Lllls app,l.1 cHltJon fp!: \/h I 'Ih t:lu:lY
<br />HIll Le> l:f;lSponsJbla. If \'01\, as the OIH1EH Sl(JIIS as Lilt: C1oI1traotol, you are Jlld,lnaUng Lhi:lL
<br />VOlI, nll:IHH than the c:olltr:aotor, ara l.'espons.tblti tOt' Lhe llOrk. it the COIlt:,nwI.:Ol: Illslles
<br />i'llll to f:j,i \.III as oontnwtol. that lIlay be all jndJ.ui~tJfJll l:hat he 101 not ploperly 1.1 uallSfHl alld j OJ
<br />nul allt! tIed to penllll:UlIg pdvilegea Jll [-,he UJl:y of 2,ephYLldl16.
<br />I:. 'J'H/IHBPUH'J'}\.'l'ION 1t1PAC'1' FlllmS I\IIIJ U'j'ILJ'l'Y COllllme'l'IOII Jj'hlHlS
<br />n. ClJIIS'l'RIlC'.l'IlHHI LTI1lII }Imv lCllAP'l'I!JH '113, WI,ORIIJJ\ ,'j'l'A'l'lJ'['mB, AS lIt10:NDB:n)
<br />I oerU ty that I, l:he GlppI.JrJalll:, halla hafm (ir(')\fl.'~ed 11U'h a oopy of "jj"IC>.I:'hhl't:I C:onstt'llfltl'lll
<br />11fill LOlli . !InlllfWI'/lli;U;' ij I?roj;eation Guide" prepared by the B'.loJ:lda lleparl:lllt:lnl: of 1~\Jl,1 Gllll:lUill
<br />~lld CUllf:lUlller Ilttajrf:l, If the applicant is SOHliwue ol:\tcn: that the "[Hiller", 1 uer.lty Lha!: J
<br />halfCi (,)Ill:alued a (jopy of tile ah()v~ delilClribed domunent aud proll1ise In good t~.Ith t.o d/iiilj 11tH'
<br />j L to l.hl;l "u\'Illel:/f pd,OJ: to OOllllnenU61ilellL.
<br />n:. CON'l'H/IC'j'OH' S/uWIIIlin' S Jlli'H'JIlJ\Vl'l'
<br />I (JeLt,j ty Lha!: /:I] 1 the informaUon :In \:Ills appUcat.l on .liS aneuraLe and Lhal', all \/Cal, 11111
<br />lIe doue I.IJ uOlllp1 lance Hi tll aU, applioabla laws reglllatiug (lOnstrllol:l.nl1, zon1.ny, alld ll'\lld
<br />deve loplllelll:,
<br />j\ppl..loaL.J.oll Is herehy mClde to obta,in a permlt: 1:0 do Hod, anr1 Jnsl:Clll.aLloll as indinitted. .I
<br />ce1:l:Jfy \:haL 110 Ilarl~ Ill' installaUon has oomlllenaed pr.1.p\.', to il:lIi\li:lIWa of ~ penrdl:. and Lila!:
<br />all vlol.lr Hit I IH:l pel:fonned to lIIeet at~ndar.ds of all laws t'egllJat.:1IlU OOllsL1:IlLll.loll, (:Il:y
<br />(lodes, :i:ollIllU reYlIlaU.olls, and lClud developllumt rtlYIl1.\l:.!.olls in the JI11:J"dluLlon, T allijo
<br />celL! fy I.llal: '[ 1IlHleli:iLalld tllat the u,glllal:lolll:l of other goveUlIl\enl:al agentlles llIay I:lppl II to
<br />lilt. lnttHlClcHi vmJ:!., fwd l:ll~t l.t. .j.a my l;'il~PP1HI.u~,Uj,ty to ldelll::1fy \'1h~t aotJollS I lIIlIst l.al;e 1:0
<br />llt: l.n clllllpl.1 tllIOIil, 8lWh agencies 1n0111de but al.e liD\: ll.nd,t.ed to I ~ Depar.tment: of
<br />E:nvlnllllllelll:al HE:\JILI atiOll"CYfJl:et.lS BRyheads, Wel:lalld AL'ei:l1':l i:llldl~nvjrollmelll,alty t:lells.lt::IVtl
<br />Lallr,ls, Wj;tLeL'/Wi:lSl.wal:er 'j'1:ealIll611t
<br />'i:l()1I1:1l\~t:/;i1: li'lodcla ~vatel' Nqna~HllllellL lLl.std ot-WelJs, Cyp1'el:ls Bayheads, ~VE:ll.lalld 111:61:16,
<br />}\IIt:lr.llJ\j Wcd:enJOI1J:1iI6S
<br />'l,rIllY Cor(l9 Df IlillgJlleer.a-Seal'lalls, Docila, Navigable Waten'lays
<br />}'}Ji;';pcHlulent of lIeallh & RehabJlltcll;lve SeJ:viues, li:nvL:Ollllleutal Health IJnH:---Welll:lf
<br />WC:ll'Jl:e~laLi'Jc 'j'J:f:EtLmelll:, Sefltic 'l'anJ,13
<br />I'll, S. llillvJ 1:011Hlenl:a.1. l:l!:CJtEiCltioll }\gency-'Asbestos abatemelll:
<br />'I i:illiO clel.I.IEy that., if f.l.JllllateeJal:16 to be IHllIfH.t.1n I!'lood Zone "A" Dr. "ll,eLn,", JI. :Is
<br />11llde:UiLood Lhat a dtaJlIage piau addressing f:l "oompensat.i.ng VOlllllle" \-'/1.11 be allllllll U:lld VlhJ.uh
<br />Is pJ:epal.er! by a 11lofesl:d.oual englnfHll, .t:egJstsred in the SI:at.e of /J'lOl':I.da pllu!:' 1:0 penlllt:
<br />,isallallU~ .
<br />h perml \; j saIled aha 11 be construed to be a lJoense to ptooeed IIi th the vwr)t AlId nol: as
<br />i:llIthor:lLy to vlCllate, canuel, alter, or set as.l.de any pl'ov:la:lons of Lhe teohn.lnal OOdCiS,
<br />nor shall lslHlance of a peJ:IIlll' pr.eveut the Bll,UCU1H] ()ffl.nJal fnJIlI Lhe~f':lafLiH' 1:111]1111;1119 1:I
<br />noneuUClII of errrns ill plalls, uon~t;!:uQtjOl\, or Vi.ul!!ll;iollli of anv QuUe. Illlli,ty lHu:l/Ii.t
<br />Jijijllllld lilli~ll henorne invdh\ IInl~a(j th~ woX;!< iHj~hor:J~.d by suah ptH'OI:1 t Js 1I01llllltilllOEHi Id l:ld II
<br />f;l.111 1II11lltllti of iaSlIftlWe, Qk: Lf. Heir.\{ allthodzed hy the petlult 1.s suspeuded or aballdnned .tot' a
<br />ped,od of sll> lI1DlIl:hs attar the LJllle the Harle is OOlllIllenuBd. One 90 daV el,l:elllil.iLJll uf tIme
<br />may ba a'llo\'/ed tOt thel pennlt vlith tae cJharge of ~15.00. 'l'he Bletenslnn sludl ba l,eque;sl:ec\
<br />.III w:iL.1n\j to the BllJ.ldlny otfJcJll;ll. An approved lnspeuUon mua\; be JO\Jy=d dllclng e<lnll i:lJ11
<br />1II0nth pedIJd, OJ: the proJeot: I,d!! be l1011sJdared alJf\IHloned.
<br />\tOlmlJlI1.3 'J'O OWNIilRI 'to\JH b~.A[IoURIll '1'0 RlllC(JRD A. Hunchl OF.' CONt1BlNCHiI'IHHrJ' N/\.Y HIiiHIJI.'I' III YlIllfl
<br />I?l\YHIG 'l'WICli: UUH U1PHOVH:lvlIDN'f','3 '1'0 YOUR PHOli'IW'l'Y. TH' YOU IJI'l'fi:I/D '1'0 UB'I'I\HI Il'HIAlllJlIHa, COIISII!.'I'
<br />\lOTII )'OIIH l,HltWIDH OR I\H A'I"j'DRI'lF.lY BIlJIl'DRl:l\ RIDCORDIHt3 YOUR IHYI'ICm Oli' COlvlNH:NCfl:lvlH:H'I'. ,mUH IJI.JIJf!:H
<br />~2, 500 HI VAJ,lIfi: DO I'IO'J' NUiIDD '1'0 RH\CORD AND I?OS']' A "HO'l'TCU: Ol!' cm'1l1/.i:lICn:HU:U'l'/I,
<br />
<br />'-,'_'nUL J,.'LI.;)l"Uj !)).~. ,':',~~~~,"'\~!:j:\ l\El~"~:::)A'VIT'
<br />
<br />091 GlIJ\'l'lInt!i I CJWNlllft oH 11(30:tI'I'
<br />
<br />~_...-.. '-'~-'....,-_..--._,... . '--'~'-------..-~_.....".__._,-_.. -..
<br />
<br />SlGlIJ\'l'lIHlli I CON'I'flAC'I'UH
<br />
<br />f:j'I'/\'J'61 un' 1!'J,URlIl1\
<br />
<br />(!Oll WI' 'i lJ H'-,.....,.........-,...." ...___...,_,____.._,_.._....__, '__,...._,_'..'__....,
<br />
<br />'J'lle tClJ:.e:gu.1119 iUIj\:1:\Ilnanl: Has aaknowl.edged
<br />BeEole me tills.., """ day ot,_..,..____......1 l!t.....
<br />
<br />by. __, .. _....... .'__'_" ., ..... _.._,. '......, .......,.,., ._._..,......._._...,...__"_ '_ .....'.._.,..__,_..,...,.
<br />' (nallle of parson ilLllmo\'llelliged)
<br />J 11110 1s pel:soncdly kllown 1:0 me, Ol'
<br />
<br />fl'I'J.\'I'1ll Oil' Ii'LORIlJA
<br />
<br />CnUN'I'Y DI!' ...__..__. ,.._......."......,_. '.........,_,..... ....,..._...,
<br />
<br />'J'he toregoing insl:nuflent Has au)moHI edyiul
<br />Bflfore me Udli _............J,tay of...,......,....._, HI_~...
<br />
<br />b V .,....,_.._,.........,_,_................,..,......___, _ .....'........'...,.'..'__..".............,....,....
<br />(namEl of perSOIl aolmql'd IiilC.tU~u.t1
<br />LJ,ho Js pfu:F.lonalJy IcnOlyn 1:0 1lIIiil, 01:
<br />
<br /><) !let S P r.odlloed.... ....._....__..........,._.._,..~........._._...,
<br />(type of JdenUEloat!onl
<br />"I L1dld not take an oath.
<br />
<br />[I ":Iho lIa El p todll(Jed__"..._..__,___.._....,.._~..._.
<br />(type of Idtlll\:LHmil.lnn)
<br />and ViIIO []dJd DUd nol: ta)~.. om oath
<br />
<br />.......... '
<br />
<br />La Id.ng 'f.iulmovlLedgemen (,
<br />
<br />----. '_..."..--_..,......._~_~...H__"'_.._. ."......_..,..,_.,...""._...~.. .,___.._.~. .......~~._~~... ... ..,__ _~.......~._.__. ..,_ ._._
<br />
<br />Sl.gnat:\lt'e of persoll ted, l.uIJ <101"10\1 1 edglllent I
<br />
<br />.... .._....-._.-..._-,,-...~~..
<br />~;l...;;~:.,~'I:~ mp e d
<br />
<br />-.-..---~- ......._ ..".....-...~.H_._'._._.. ......
<br />l/alllE! typed, [lrJlIted ur IOII:amjltHI
<br />
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